Provider Demographics
NPI:1811397839
Name:RIORDAN, EMILY MARY (PTA)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:MARY
Last Name:RIORDAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W MEYER LN APT 15301
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-8128
Mailing Address - Country:US
Mailing Address - Phone:414-412-3754
Mailing Address - Fax:
Practice Address - Street 1:1703 60TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-3986
Practice Address - Country:US
Practice Address - Phone:262-658-4125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2149225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant